UNIVERSITY OF WASHINGTON, Department of Health Services 
EXTENDED MPH DEGREE PROGRAM 
Email:  uwedp3@u.washington.edu 
(206) 685-7580 
MPH THESIS COMMITTEE APPOINTMENT CONTRACT 

This contract must be completed and returned to the Extended MPH Degree Program (uwedp3@u.washington.edu) before a student may register for EDP Thesis (HSERV 700) credits. 

DIRECTIONS FOR USING THIS FORM 
1) The student copies and pastes the etirety of this template into their email.  Fill out the email template at the appropriate blanks. 
2) The student uses their UW email account to send the form by email to their chair/committee members and to ExDP at uwedp3@u.washington.edu
3) The chair/committee member reviews and states his/her approval of the content/goals on the form and sends the entire communication back to ExDP at uwedp3@u.washington.edu

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STUDENT
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Student Name: 

Thesis Topic: 



The Chair must be an approved member of Graduate Faculty.  Please use the Graduate Faculty Locator (http://www.grad.washington.edu/gradfac/) to verify.  

Committee Member(s) must be current UW faculty.


FACULTY
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This topic has been approved and I have agreed to serve as this student’s: (Please Mark an ‘X” in One) 
_____Committee Chair	
_____Committee Member	

Name:
Department:
Address or Box Number:
E-mail:
Phone number: